title: Blood, and not urine, BK viral load predicts renal outcome in children with hemorrhagic cystitis following hematopoietic stem cell transplantation.
abstract: BK virus is a significant cause of hemorrhagic cystitis after hematopoietic stem cell transplantation (HSCT). However, its role in nephropathy post-HSCT is less studied. We retrospectively evaluated clinical outcomes in pediatric HSCT patients with hemorrhagic cystitis. Although most of these patients had very high urine BK viral loads (viruria), patients with higher BK plasma loads (viremia) had significant renal dysfunction, a worse clinical course, and decreased survival. Patients with a peak plasma BK viral load of >10,000 copies/mL (high viremia) were more likely to need dialysis and aggressive treatment for hemorrhagic cystitis compared to patients with ≤ 10,000 copies/mL (low viremia). Conversely, most patients with low viremia had only transient elevations in creatinine, and less severe hemorrhagic cystitis that resolved with supportive therapy. Overall survival (OS) at 1 year post-HSCT was 89% in the low viremia group and 48% in the high viremia group. We conclude that the degree of BK viremia, and not viruria, may predict renal, urologic, and overall outcome in the post-HSCT population.
authors.affiliation: Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
authors.forename: Hilary L
authors.initials: HL
authors.lastname: Haines
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Laskin
authors.forename: Jens
authors.initials: J
authors.lastname: Goebel
authors.forename: Stella M
authors.initials: SM
authors.lastname: Davies
authors.forename: Hong J
authors.initials: HJ
authors.lastname: Yin
authors.forename: Julia
authors.initials: J
authors.lastname: Lawrence
authors.forename: Parinda A
authors.initials: PA
authors.lastname: Mehta
authors.forename: Jack J
authors.initials: JJ
authors.lastname: Bleesing
authors.forename: Alexandra H
authors.initials: AH
authors.lastname: Filipovich
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Marsh
authors.forename: Sonata
authors.initials: S
authors.lastname: Jodele
mesh_terms: D001739:BK Virus; D002648:Child; D003404:Creatinine / Q000097:blood / Q000652:urine; D003556:Cystitis / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000652:urine / Q000821:virology; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006470:Hemorrhage / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000652:urine / Q000821:virology; D006801:Humans; D008297:Male; D027601:Polyomavirus Infections / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000652:urine; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D014184:Transplantation, Homologous; D019562:Viral Load; D014766:Viremia
chemical_list: D003404:Creatinine